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Reis NC, Handspiker EA, Bauerle WB, Reese V, Benton AJ, Castillo RC, Robins LK, Ramirez CL, Braverman MA, Thomas PG. FAST and Furious About Quality: Impact of Continuous Review and Feedback on Point-of-Care Ultrasound Examinations. Am Surg 2024:31348241257465. [PMID: 38787334 DOI: 10.1177/00031348241257465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background: Focused Assessment with Sonography in Trauma (FAST) examination is a point-of-care ultrasound study used to evaluate for abdominal hemorrhage, pneumothorax, or pericardial blood in trauma patients as an adjunct to their initial assessment. The quality of the image can be limited, and its diagnostic value is heavily dependent on operator skill. Our objective was to determine whether a standardized review process improved image quality and reduced incidence of nondiagnostic or insufficient imaging by 10% over a 6-month period. Study Design: Between July 1, 2021, and March 31, 2022, we evaluated 1106 trauma activations at our level II trauma center. Two exams per practitioner per month were reviewed by an emergency medicine trained traumatologist with specialized training in point-of-care ultrasound and board certification in echocardiography. Priority was given to exams on patients with known injuries identified on other studies. If there were no exams that matched these criteria, random exams were selected. Images were reviewed for image quality, diagnostic accuracy, and labeling with counseling given to the provider if indicated. Categorical variables were compared using chi squared analysis, while continuous non-normally distributed variables were compared using the Mann-Whitney U test. Results: A total of 305 FAST exams were reviewed (186 pre-intervention and 119 during intervention). Image quality improved from 46.3% (n = 31/65) to 79.0% (n = 94/119) (P < .01) with need for counseling falling from 63.1% (n = 41/65) pre-QI to 42.0% (n = 50/119) post-QI (P < .01). Incidence of detectable injury, BMI, ISS, and AIS body regions were consistent across the study period. This was seen in both the geriatric and non-geriatric cohorts despite a significant increase in ISS in the post-intervention geriatric patients.Discussion: A FAST review program is associated with improvement in image quality and decreased need for counseling of trauma providers.
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Affiliation(s)
- Nicholas C Reis
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Erin A Handspiker
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Wayne B Bauerle
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Vanessa Reese
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Adam J Benton
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Roberto C Castillo
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Lisa K Robins
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Christine L Ramirez
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Maxwell A Braverman
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Peter G Thomas
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
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Yu Z, Alhamadani MA, Chehade M, Wright DB. Idiopathic pseudoaneurysmal omental bleeding, a rare cause of life-threatening acute abdomen. J Surg Case Rep 2024; 2024:rjae048. [PMID: 38389512 PMCID: PMC10881295 DOI: 10.1093/jscr/rjae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Mesenteric aneurysms and their complications can be a life-threatening presentation of acute abdomen to the emergency department. The majority of mesenteric artery aneurysms are incidentally detected on imaging investigations and are asymptomatic. Symptomatic mesenteric aneurysms manifest as hemoperitoneum or abdominal pain. In addition, treatment of symptomatic aneurysms is delayed due to the infrequent consideration of the diagnosis in patients presenting with abdominal pain. Timely and accurate diagnosis is of paramount importance as any delay in definitive surgical management can lead to increased patient's mortality and morbidity with up to 25% of mesenteric aneurysms may be complicated by rupture.
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Affiliation(s)
- Zirong Yu
- Department of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Mohammed Ali Alhamadani
- Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Marthe Chehade
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Danette B Wright
- Clinical Network Director Surgery, Western Sydney Local Health District, Blacktown, New South Wales, Australia
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Atalla M, Yacoub A, Al-Ali H, Lupia B, Ezzeddine L, Barzani S, Moussa M, Coey J, Alambrouk T, Hilal H. Investigating the Skill Development of Medical Students in Focused Assessment With Sonography for Trauma (FAST) Ultrasound: A Comparative Analysis Across Different Stages of Medical Training. Cureus 2023; 15:e44414. [PMID: 37664275 PMCID: PMC10469331 DOI: 10.7759/cureus.44414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Focused assessment with sonography for trauma (FAST) ultrasound (US) is a valuable medical examination used in trauma settings, particularly for rapid responses to events such as natural disasters. Although the efficacy and benefits of FAST in patient care have been extensively studied, there is limited research on training medical students in FAST. Previous studies have found that medical students can proficiently perform a FAST US after two days of training. However, these studies exclusively included first-year medical students without considering variations in their medical knowledge. Particularly, the advantage of medical students having US experience before undergoing FAST training has not been previously examined. OBJECTIVES Assess the performance and knowledge acquisition of medical students with and without prior US experience after completing a FAST training course. METHODS The study included a total of 71 students, consisting of 33 males and 38 females, who were between the ages of 18 and 31, with an average age of 24.6 and a standard deviation of 2.4. The inclusion criteria targeted first- and second-year medical school students who participated on a volunteer basis. Students were divided into two groups: group A, consisting of those without prior US experience, and group B, made up of those who had previous US experience. All students completed a pre-training survey to share their comfort and confidence in US use and knowledge. A baseline FAST exam was conducted to establish initial performance. A comprehensive three-hour training session was then provided. Post-training, students performed another FAST exam to assess improvement, followed by a post-training survey to evaluate comfort and confidence. RESULTS Medical students who had prior experience in the US (group B) performed significantly better (p<0.01) in both the pre- and post-training FAST exams when compared to students without previous US experience. Specifically, in locating the liver, right kidney, hepatorenal recess, and left kidney, as well as detecting fluid accumulation when in a supine position. Additionally, medical students with prior US experience (group B) exhibited higher baseline confidence (p<0.005-p<0.01) in their ability to perform a FAST exam, as indicated by the results of the pre-testing survey. CONCLUSION Previous experience with US significantly boosted confidence and knowledge gains following FAST training. This emphasizes the value of including US training in medical school programs after earlier exposure, offering evident benefits. The study reveals the unexplored benefit of having prior US experience for medical students undergoing FAST training, thus addressing a previously unexplored area in current research. The conclusions stress the necessity of integrating US training into medical school curricula after initial exposure. This understanding can direct medical educators in refining the education process, enabling students to be better equipped for real-world medical situations involving FAST.
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Affiliation(s)
- Michael Atalla
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
- Medical Imaging, University of Toronto, Toronto, CAN
| | - Andrew Yacoub
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Hasan Al-Ali
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Bianca Lupia
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Layal Ezzeddine
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Shaliz Barzani
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Michelle Moussa
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
- Faculty of Science, University of Waterloo, Waterloo, CAN
| | - James Coey
- Anatomy, St. George's University School of Medicine, Newcastle upon Tyne, GBR
| | - Tarek Alambrouk
- School of Medicine, St. George's University School of Medicine, Newcastle upon Tyne, GRD
| | - Haider Hilal
- School of Medicine, St. George's University School of Medicine, Newcastle upon Tyne, GBR
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Abstract
Massive trauma remains the leading cause of mortality among people aged younger than 45 years. In this review, we discuss the initial care and diagnosis of trauma patients followed by a comparison of resuscitation strategies. We discuss various strategies including use of whole blood and component therapy, examine viscoelastic techniques for management of coagulopathy, and consider the benefits and limitations of the resuscitation strategies and consider a series of questions that will be important for researchers to answer to provide the best and most cost-effective therapy for severely injured patients.
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Affiliation(s)
- Carter M Galbraith
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, JT 845, Birmingham, AL 35249, USA
| | - Brant M Wagener
- Division of Critical Care Medicine, University of Alabama at Birmingham, 901 19th Street South, PBMR 302, Birmingham, AL 35294, USA; Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th Street South, PBMR 302, Birmingham, AL 35294, USA
| | - Athanasios Chalkias
- Department of Anesthesiology, University of Thessaly, Biopolis, Larisa 41500, Greece; Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Shahla Siddiqui
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO 80045, USA.
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Harris J, Vassallo S, Finan CD, Kalivoda EJ. Point‐of‐care ultrasound evaluation of blunt abdominal trauma. J Am Coll Emerg Physicians Open 2022; 3:e12786. [PMID: 35874454 PMCID: PMC9299571 DOI: 10.1002/emp2.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Justin Harris
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME Consortium HCA Florida Brandon Hospital Brandon Florida USA
| | - Salvatore Vassallo
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME Consortium HCA Florida Brandon Hospital Brandon Florida USA
| | - Carlie D. Finan
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME Consortium HCA Florida Brandon Hospital Brandon Florida USA
| | - Eric J. Kalivoda
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME Consortium HCA Florida Brandon Hospital Brandon Florida USA
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He NX, Yu JH, Zhao WY, Gu CF, Yin YF, Pan X, Zhong H. Clinical value of bedside abdominal sonography performed by certified sonographer in emergency evaluation of blunt abdominal trauma. Chin J Traumatol 2020; 23:280-283. [PMID: 32762981 PMCID: PMC7567895 DOI: 10.1016/j.cjtee.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/18/2020] [Accepted: 06/15/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma. METHODS The study was carried out from 2017 to 2019. Findings in operations or on computed tomography (CT) were used as references to evaluate the accuracy of bedside abdominal ultrasonography. The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application. RESULTS Bedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma, of which 71 critical patients received surgery. The overall diagnostic accordance rate was 88.68%. The diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation, retroperitoneal hematoma and multiple abdominal organ injury were 100%, 94.73%, 94.12%, 20.00%, 100% and 81.48%, respectively. Among the 71 critical patients, the diagnostic accordance rate was 94.37%, in which the diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation and multiple abdominal organ injury were 100%, 100%, 100%, 20.00% and 100%. The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan (4.45 ± 1.63 vs. 2.38 ± 1.19) min; however, the mean waiting time before examination (7.37 ± 2.01 vs. 16.42 ± 6.37) min, the time to make a diagnostic report (6.42 ± 3.35 vs. 36.26 ± 13.33) min, and the overall time (17.24 ± 2.33 vs. 55.06 ± 6.96) min were shorter for bedside abdominal ultrasonography than for CT scan. CONCLUSION Bedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma. Especially for patients with free peritoneal effusion and critical patients, bedside ultrasonography has been proved obvious advantageous. However, for negative bedside ultrasonography patients with blunt abdominal trauma, we recommend further abdominal CT scan or serial ultrasonography scans subsequently.
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Affiliation(s)
- Nie-Xia He
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jin-Hui Yu
- Department of Neurosurgery, Chongqing Yubei District People's Hospital, Chongqing, China
| | - Wan-Yi Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chun-Fang Gu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ya-Fei Yin
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xu Pan
- Department of Ultrasound, Chungking General Hospital, Chongqing, China
| | - Hua Zhong
- College of Biomedical Engineering and Imaging Medicine of Army Medical University, Chongqing, China,Corresponding author.
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7
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Candel BGJ, Admiraal-van de Pas Y, Smit-van de Wiel F. Suspicion of abdominal injuries in high-energy trauma patients: which clinical factors influence decision making for diagnostic imaging? Acta Chir Belg 2020; 120:223-230. [PMID: 32427054 DOI: 10.1080/00015458.2020.1771894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The choice of diagnostic imaging for high-energy trauma (HET) patients is highly debated. Currently, different diagnostic imaging is used in trauma centres to identify abdominal injuries. However, it remains unclear when physicians have a suspicion for abdominal injuries, and when diagnostic imaging is performed. Over-triage may lead to unnecessary diagnostics in relatively minor injured HET-patients.Purpose: We investigated which clinical factors influence the decision to perform a focused assessment with sonography in trauma (FAST) or abdominal computed tomography (CT) in HET-patients. Additionally, we investigated which clinical factors determined whether HET-patients were admitted to the hospital or discharged from the emergency department.Methods: We performed a retrospective data analysis of all HET-patients in a single level II trauma centre in the Netherlands, between June 2015 and January 2017.Results: 316 HET-patients were included in this study. We found two clinical factors that proved to significantly predict whether a FAST or abdominal CT was performed: abdominal pain and the degree of concomitant injury. Furthermore, we found that the degree of concomitant injury as well as low haemoglobin levels proved to significantly predict whether a patient was admitted to the hospital for observation.Conclusion: This study clarifies on which clinical factors the decision is taken to perform diagnostic imaging to identify abdominal injuries. Future prospective multicentre studies should clarify whether these clinical factors are trustworthy predictors of abdominal injuries, and whether patients can safely be discharged after trauma work-up.
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Affiliation(s)
- Bart G. J. Candel
- Department of Emergency Medicine, Máxima Medical Centre, Veldhoven, The Netherlands
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8
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Basnet S, Shrestha SK, Pradhan A, Shrestha R, Shrestha AP, Sharma G, Bade S, Giri L. Diagnostic performance of the extended focused assessment with sonography for trauma (EFAST) patients in a tertiary care hospital of Nepal. Trauma Surg Acute Care Open 2020; 5:e000438. [PMID: 32789187 PMCID: PMC7389771 DOI: 10.1136/tsaco-2020-000438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/28/2020] [Accepted: 06/20/2020] [Indexed: 12/04/2022] Open
Abstract
Background Thoracoabdominal trauma presents a diagnostic challenge for the emergency physician. The introduction of bedside ultrasonography (USG) provides a screening tool to detect hemoperitoneum, hemothorax, pneumothorax and pericardial effusion in torso injuries. Aim To evaluate the accuracy of extended focused assessment with sonography for trauma (EFAST) for chest and abdominal injuries performed by first responders in a tertiary care hospital of Nepal. Methods This was a prospective study including all trauma patients who obtained either an Injury Severity Score ≥15 or direct trauma to the trunk in 1 year period in the emergency department (ED) of Dhulikhel Hospital-Kathmandu University Hospital. The results of the EFAST were then compared with contrast-enhanced CT (CECT), radiology ultrasound (USG)/chest X-ray, or intraoperative findings when the EFAST was positive. The negative EFAST cases were observed for a minimum of 4 hours in the ED. Descriptive statistics and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Results Out of 267 cases, 261 patients underwent an EFAST examination. The sensitivity and specificity were 94.8% and 99.5%, respectively. The negative predictive value was 98.53% whereas the positive predictive value was 98.21%. The overall accuracy was 99.4%. Conclusion The results of this study suggest that EFAST examination performed by first-line healthcare providers is a useful method for assessment of thoracic and abdominal injuries. EFAST was found to have a high specificity (99.5%) and positive predictive value (98.21%) which indicates that it is an effective technique for detecting intra-abdominal or thoracic injuries. However, the effectiveness of EFAST is limited by its being operator dependent, and thereby human error. For negative EFAST cases, we recommend a monitoring period of at least 4 hours, serial fast scan, or further investigation through other methods such as a CECT. Level of evidence Level I
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Affiliation(s)
- Samjhana Basnet
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Sanu Krishna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Alok Pradhan
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Roshana Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Grishma Sharma
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Sahil Bade
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Latika Giri
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
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Hosseininejad SM, Bozorgi F, Assadi T, Montazar SH, Jahanian F, Hoseini V, Shamsaee M, Tabarestani M. The predictive role of amylase and lipase levels on pancreas injury diagnosis in patients with blunt abdominal trauma. Horm Mol Biol Clin Investig 2020; 41:hmbci-2019-0066. [PMID: 32374282 DOI: 10.1515/hmbci-2019-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/04/2020] [Indexed: 12/26/2022]
Abstract
Objectives Despite the low incidence of pancreatic injury in the abdominal blunt trauma (BTA), its early diagnosis is very important; since pancreatic injury is associated with high rates of morbidity and mortality. However, due to the high association of pancreatic injury with injury of other abdominal organs, its diagnosis may be delayed and complicated. The use of imaging modalities is also subject to limitations for reasons such as cost, unavailability, and harmfulness. Consequently, the present study aimed to investigate the predictive role of amylase and lipase enzyme levels in the final diagnosis of pancreatic injury in patients with BTA. Methods In a prospective diagnostic study, 384 patients with BTA referring to Imam Khomeini hospital of Sari (north of Iran) were enrolled according to the inclusion and exclusion criteria. Initial patient data including age and sex were recorded. Blood samples were analyzed in the laboratory to measure complete blood count (CBC), amylase and lipase enzyme levels. Patients were followed up during hospitalization and focal ultrasound for abdominal trauma (FAST), CT-Scan and laparotomy results were recorded. Finally, the data was analyzed using SPSS version 22. Results The level of amylase enzyme was significantly higher in males (p = 0.04), but the level of lipase enzyme was not significantly different between two genders (p > 0.05). The most common symptoms and signs in patients were pain, tenderness, and hematoma, respectively. The frequency of pancreatic injury in all patients with blunt abdominal trauma was 7.5% based of FAST, 7% based on CT-Scan and 12.4% based on laparotomy. Comparison of laboratory findings based on FAST, CT-Scan and laparotomy results showed that the level of amylase and lipase enzymes in patients with internal organ and pancreatic damage were higher than in patients without internal organ injury (p < 0.05). But based on FAST results; patients with pancreatic injury and injury of other organs had no significant difference (p > 0.05). However, comparison of laboratory findings based on CT-Scan and laparotomy results showed a significant increase in the level of amylase and lipase enzymes in patients with pancreatic trauma compared to patients with injury of other organs (p < 0.001). Conclusions The results of this study showed that pancreatic injury in blunt trauma is associated with a significant increase in levels of amylase and lipase enzymes. In addition, an increase in levels of amylase and lipase enzymes is associated with internal organ damage. Serum amylase and lipase levels can be used as useful biomarkers to decide whether to perform CT-Scan or laparotomy.
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Affiliation(s)
- Seyed Mohammad Hosseininejad
- Department of Emergency Medicine, Diabetes Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Farzad Bozorgi
- Department of Emergency Medicine, Gut And Liver Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Touraj Assadi
- Department of Emergency Medicine, Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Seyyed Hosein Montazar
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Fatemeh Jahanian
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Vahid Hoseini
- Department of Emergency Medicine, Gut And Liver Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Mahboobeh Shamsaee
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Mohammad Tabarestani
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
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Pigneri DA, Behm RJ, Granet PJ. Rolling a trauma patient onto the right side increases sensitivity of FAST examination. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:152-155. [PMID: 31820823 DOI: 10.1002/jcu.22797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/24/2019] [Accepted: 11/09/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Hemoperitoneum in the hypotensive trauma patient is an indication for emergent laparotomy. Focused assessment sonography in trauma (FAST) is a widely used tool for detecting hemoperitoneum. The usefulness of FAST is currently limited by low sensitivity. We hypothesize rolling patients onto their right side will pool small volumes of fluid into the right upper quadrant of the abdomen leading to increased sensitivity. METHODS Peritoneal dialysis patients were recruited for voluntary participation in a small pilot prospective clinical trial. Each participant first underwent a supine FAST followed by a 30-second roll onto the right side. Once back in the supine position, the FAST was repeated (FASTeR or FAST examination after right-sided roll). About 50 mL aliquots of dialysate were sequentially infused into the abdomen and the imaging sequence repeated until a positive finding was obtained. RESULTS Seven patients were consented for the study. One patient was found to have an equivocal examination secondary to renal cysts. All six remaining participants converted to a positive FASTeR at an intra-abdominal fluid volume at which standard FAST was negative. CONCLUSIONS Rolling patients to the right side increased FAST sensitivity, converting false-negative to true positives examinations. A larger study is needed to validate our preliminary data.
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Affiliation(s)
- Danielle A Pigneri
- Division of Trauma and Surgical Critical Care, Guthrie Clinic, Sayre, Pennsylvania
- Division of Trauma and Surgical Critical Care, Memorial Regional Hospital, Hollywood, Florida
| | - Robert J Behm
- Division of Trauma and Surgical Critical Care, Guthrie Clinic, Sayre, Pennsylvania
| | - Paul J Granet
- Division of Trauma and Surgical Critical Care, Guthrie Clinic, Sayre, Pennsylvania
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11
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Boutros SM, Nassef MA, Abdel-Ghany AF. Blunt abdominal trauma: The role of focused abdominal sonography in assessment of organ injury and reducing the need for CT. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2015.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Samer Malak Boutros
- Radiodiagnosis department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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12
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Ketelaars R, Van Heumen E, Baken LP, Witten M, Scheffer GJ, Engels Y, Hoogerwerf N. Emergency physicians’ attitudes to implementing ultrasound in Dutch emergency departments after a 2-day training: A qualitative study. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918771812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Diagnostic ultrasound is increasingly used by nonradiologists in trauma victims and critically ill patients. In the emergency department, the extended focused assessment with sonography for trauma and Polytrauma Rapid Echo-evaluation Program protocol are often used to assess these patients. Dutch Polytrauma Rapid Echo-evaluation Program-trained Emergency physicians are implementing the use of ultrasound in the emergency department but might encounter barriers to overcome. Objectives: This study aims to explore individual experiences of Dutch emergency physicians. Methods: We performed a qualitative study by conducting semi-structured interviews in Dutch emergency physicians working in a Level 2 emergency department that completed the 2-day Polytrauma Rapid Echo-evaluation Program course at least 1 year before the interviews. Data were analyzed using directed content analysis. Results: Eight emergency physicians employed by eight different hospitals were interviewed. Thirteen categories were identified in the transcribed interviews and these were combined into four general themes: (1) the desire to develop the Emergency Medicine specialty, both nationally and local; (2) incentives to start using ultrasound; (3) exploring practical applications of ultrasound; and (4) barriers faced while implementing emergency physician-performed ultrasound on the emergency department. The interviewees regard the course to be a solid base and are eager to independently perform ultrasound examinations, although challenges are faced. Conclusion: This exploratory study provides essential insight in Dutch emergency physicians implementing ultrasound in their emergency department. It shows that there is a need to develop a quality assurance system and it identified barriers that have to be dealt with.
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Affiliation(s)
- Rein Ketelaars
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Helicopter Emergency Medical Service, Lifeliner 3, Radboud university medical center, Nijmegen, The Netherlands
| | - Esther Van Heumen
- Department of Radiology, Haga Hospital, The Hague, The Netherlands
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lambert P Baken
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Marja Witten
- Emergency Department, Flevoziekenhuis, Almere, The Netherlands
| | - Gert Jan Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Nico Hoogerwerf
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Helicopter Emergency Medical Service, Lifeliner 3, Radboud university medical center, Nijmegen, The Netherlands
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Fahrner R, Rauchfuss F, Scheuerlein H, Settmacher U. Posttraumatic venous gas in the liver - a case report and review of the current literature. BMC Surg 2018; 18:14. [PMID: 29499671 PMCID: PMC5834843 DOI: 10.1186/s12893-018-0345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background There are numerous causes of hepatic gas formation that range from serious pathologies to incidental findings, including mesenteric infarction, liver abscess, inflammatory bowel disease or minimally invasive hepatic interventions. Case presentation We report a case of a 50-year-old man who was admitted to the emergency room after a car accident. The clinical examination and further diagnostics revealed a craniocerebral injury with a fracture of the skull, concomitant soft tissue lesions and subarachnoidal bleeding. Furthermore, a blunt thoracic trauma with hemopneumothorax due to rib fractures was treated with a chest tube. No obvious abdominal pathology was seen. While in the operating theatre for the surgical revision of the cranial soft tissue lesions, a femoral venous catheter was inserted without any complications. A routine ultrasound of the abdomen six hours after the trauma revealed unclear hepatic gas formation. A contrast-enhanced computer tomography (CT) scan of the abdomen was performed, and the gas formation was found to be localized within the left hepatic vein. Afterwards, there was no specific treatment of the hepatic venous gas formation, as no alterations of liver function or liver enzymes were seen. The further course of the patient was uneventful regarding the gas formation in the liver, and another ultrasound two days later revealed no further gas in the liver. Conclusions The placement of a femoral venous catheter is a risk factor for gas formation in liver veins. No further treatment is needed in cases with stable liver function. To rule out serious pathologies, diagnostic findings (e.g., ultrasound, CT), clinical history and underlying diseases need to be analyzed carefully after the detection of intrahepatic gas formation. With contrast-enhanced CT, the localization of the gas and its potential causes might be detectable.
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Affiliation(s)
- René Fahrner
- University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany
| | - Falk Rauchfuss
- University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany
| | - Hubert Scheuerlein
- University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany.,St. Vincenz Hospital, Division of General and Visceral Surgery, Am Busdorf 2, 33098, Paderborn, Germany
| | - Utz Settmacher
- University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany
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Tsai P, Yeh Y, Yeh C. Duodenal Perforation following Blunt Abdominal Trauma Presenting as Normal in Abdominal Computed Tomography. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Most emergency department (ED) physicians implement the Advanced Trauma Life Support (ATLS) approach, including primary and secondary survey, for the assessment of blunt abdominal trauma (BAT) patients. This report emphasizes the need for repeat Focused Assessment with Sonography for Trauma (FAST) and abdominal computed tomography (CT) if a BAT patient's condition persists or worsens. After initial negative FAST and abdominal CT findings, it is recommended that BAT patients with suspected intraabdominal injury should receive repeat examination in an optimal time. We report a patient who sustained duodenal perforation following BAT diagnosed by repeat ultrasound examination and abdominal CT scan. (Hong Kong j.emerg.med. 2014;21:396-399)
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Affiliation(s)
| | - Yt Yeh
- Chung Shan Medical University, School of Dentistry, No.110, Section 1, Chien-Kuo N. Road, Taichung, Taiwan
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15
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Wong E, Ngo ASY, Wee JCP, Lee JMH. Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective This study compares the positive predictive value (PPV) and negative predictive value (NPV) of focused assessment with sonography in trauma (FAST) versus abdominal-pelvic computed tomography scans (CTAP) after blunt abdominal injury as well as the need for abdominal surgery. We also sought to determine if any false negative ultrasound studies were associated with significant morbidity. The results were compared with other studies. Design Retrospective cross-sectional study. Setting A tertiary hospital. Methods Cases were retrieved from the trauma registry and electronic medical records in a tertiary hospital in Singapore over a two year period from 1 January 2009 to 31 December 2010. Exclusion criteria included penetrating trauma and burns. The sonographic finding, computed tomography finding, and the outcome of the patients were retrieved. Diagnostic characteristics including predictive values were calculated. Results A total of 476 patients were enrolled. Four hundred fifty-nine patients had FAST performed with fifty (10.9%) being positive. Forty-nine patients (21.7%) out of 226 patients had CTAP which showed abnormalities and nineteen (4.0%) patients underwent surgery. Comparing FAST to detect abnormalities on CTAP, the PPV and NPV were 0.590 and 0.863 respectively. Comparing FAST with the need for surgery, the PPV and NPV were 0.280 and 0.990 respectively. Four patients (0.98%) had negative FAST but required surgery. There were no significant adverse outcomes or surgical intervention in patients with normal vital signs, normal initial physical examination and negative FAST findings but who did not have a CTAP. Conclusions In patients with an initial normal physical examination and negative FAST, emergent CTAP may be avoided. (Hong Kong j.emerg.med. 2014;21:230-236)
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Affiliation(s)
| | - ASY Ngo
- Jurong General Hospital, Department of Emergency Medicine, Singapore
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16
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Neeki MM, Hendy D, Dong F, Toy J, Jones K, Kuhnen K, Yuen HW, Lux P, Sin A, Kwong E, Wong D. Correlating abdominal pain and intra-abdominal injury in patients with blunt abdominal trauma. Trauma Surg Acute Care Open 2017; 2:e000109. [PMID: 29766104 PMCID: PMC5877917 DOI: 10.1136/tsaco-2017-000109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/27/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background A thorough history and physical examination in patients with blunt abdominal trauma (BAT) is important to safely exclude clinically significant intra-abdominal injury (IAI). We seek to evaluate a correlation between self-reported abdominal pain, abdominal tenderness on examination and IAI discovered on CT or during exploratory laparotomy. Methods This retrospective analysis assessed patients with BAT ≥13 years old who arrived to the emergency department following BAT during the 23-month study period. Upon arrival, the trauma team examined all patients. Only those who underwent an abdominal and pelvic CT scan were included. Patients were excluded if they were unable to communicate or lacked documentation, had obvious evidence of extra-abdominal distracting injuries, had a positive drug or alcohol screen, had a Glasgow Coma Scale ≤13, or had a positive pregnancy screening. The primary objective was to assess the agreement between self-reported abdominal pain and abdominal tenderness on examination and IAI noted on CT or during exploratory laparotomy. Results Among the 594 patients included in the final analysis, 73.1% (n=434) had no self-reported abdominal pain, 64.0% (n=384) had no abdominal tenderness on examination, and 22.2% (n=132) had positive CT findings suggestive of IAI. Among the 352 patients who had no self-reported abdominal pain and no abdominal tenderness on examination, a significant number of positive CT scan results (14%, n=50) were still recorded. Furthermore, a small but clinically significant portion of these 50 patients underwent exploratory laparotomy (1.1%, n=4). All four of these patients ultimately underwent a splenectomy and all were completed on hospital day one. Conclusion Lack of abdominal pain and tenderness in patients with BAT with non-distracting injuries was associated with a small portion of patients who underwent a splenectomy. Patients with BAT without abdominal pain or tenderness may need a period of observation or CT scan to rule out IAI prior to discharge home. Level of evidence Level III, therapeutic/care management.
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Affiliation(s)
- Michael M Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, Colton, California, USA
| | - Dylan Hendy
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Fanglong Dong
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Jake Toy
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Kevin Jones
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Keasha Kuhnen
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Ho Wang Yuen
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, Colton, California, USA
| | - Pamela Lux
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, Colton, California, USA
| | - Arnold Sin
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, Colton, California, USA
| | - Eugene Kwong
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - David Wong
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Surgery, California University of Science and Medicine, Colton, California, USA
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17
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Rahman NHN, Ahmad R, Kareem MM, Mohammed MI. Ultrasonographic assessment of inferior vena cava/abdominal aorta diameter index: a new approach of assessing hypovolemic shock class 1. Int J Emerg Med 2016; 9:8. [PMID: 26894896 PMCID: PMC4760961 DOI: 10.1186/s12245-016-0101-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 02/03/2016] [Indexed: 11/20/2022] Open
Abstract
Background We designed this study to expand the usage of ultrasound to detect early occurrence of hypovolemia. We explore the potential use of inferior vena cava (IVC) and abdominal aorta (AA) diameter index (IVC:AA) measured ultrasonographically to detect class 1 hypovolemic shock with blood loss less than 15%.ᅟ Methods The aim of this study was to determine the changes in the diameter of inferior vena cava and abdominal aorta in blood donors by using ultrasound, pre and post blood donation. The result of the study would be further explorated to determine the inferior vena cava (IVC) abdominal aorta (Aorta) diameter index (IVC:Aorta). This was a prospective study done in the blood bank of a university hospital. Researcher was trained by a senior radiologist to assess inferior vena cava and abdominal aorta diameter. Fifty-two healthy blood donors were included in the study. Inclusion criteria were same with the blood bank criteria to donate blood. Demographic data and vital signs were taken before the ultrasound measurement done for inferior vena cava and abdominal aorta diameter. Once the volunteers donated their blood of approximately 450 mls; the measurements were repeated using the same methods. Results There were differences in IVC, abdominal aorta and inferior vena cava:aorta diameters index pre and post donation. With mathematical analysis, we suggested the number of IVC:Aorta index as 1.14±2SD with SD 0.18 as a cut off value for class 1 hypovolemic shock. Conclusion The IVC:Aorta diameter index can be used as a parameter for detecting early phase (Class 1) of hypovolemic shock.
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Affiliation(s)
| | - Rashidi Ahmad
- Unit of Emergency Medicine, UM Medical Center, Kuala Lumpur, Malaysia.
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18
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Singh RP, Garg N, Nar AS, Mahajan A, Mishra A, Singh J, Ahuja A, Bawa A. Role of Amylase and Lipase Levels in Diagnosis of Blunt Trauma Abdomen. J Clin Diagn Res 2016; 10:PC20-3. [PMID: 27042519 PMCID: PMC4800585 DOI: 10.7860/jcdr/2016/14346.7308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 01/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Blunt Trauma Abdomen (BTA) is the leading cause of morbidity and mortality amongst all age groups. Spectrum of injury may vary from simple to life threatening multi organ involvement and therefore proper assessment and diagnosis becomes very important. AIM To evaluate the role of serum amylase and lipase in diagnosis of blunt trauma abdomen. MATERIALS AND METHODS This study was done on 50 patients with diagnosis of BTA admitted in Dayanand Medical College and Hospital, Ludhiana. Serum amylase and lipase levels were estimated on days 1, 3 and 5 of admission. RESULTS Road side accident was the most common aetiology accounting for 40 patients. Thirty one patients were less than 35 years of age and 42 patients were males. Abdominal tenderness was the most common per abdomen finding, found in 31 patients, followed by distension, found in 21 patients. The most common organ injured was liver, seen in 27 patients. Fifteen patients underwent laparotomy while 35 patients were managed conservatively. There was statistically significant rise in serum amylase levels on days 1, 3 and 5 in patients with small and large intestinal injury. There was statistically significant rise in serum lipase levels on days 1, 3 and 5 in patients with stomach injury. Raised levels of serum amylase and lipase had a statistically significant prediction for the need of surgery in these patients. CONCLUSION Serum amylase and lipase levels, when coupled with other laboratory tests and imaging modalities, may have significant role in predicting the site of injury as well as the surgical outcome in patients of BTA.
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Affiliation(s)
- Ravinder Pal Singh
- Associate Professor, Department of Surgery, DMCH, Ludhiana, Punjab, India
| | - Nikhil Garg
- Resident, Department of Surgery, DMCH, Ludhiana, Punjab, India
| | - Amandeep S Nar
- Assistant Professor, Department of Surgery, DMCH, Ludhiana, Punjab, India
| | - Anuj Mahajan
- Resident, Department of Surgery, DMCH, Ludhiana, Punjab, India
| | - Atul Mishra
- Professor, Department of Surgery, DMCH, Ludhiana, Punjab, India
| | - Jaspal Singh
- Professor and Head, Department of Surgery, DMCH, Ludhiana, Punjab, India
| | - Ashish Ahuja
- Associate Professor, Department of Surgery, DMCH, Ludhiana, Punjab, India
| | - Ashvind Bawa
- Assistant Professor, Department of Surgery, DMCH, Ludhiana, Punjab, India
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19
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Zanobetti M, Coppa A, Nazerian P, Grifoni S, Scorpiniti M, Innocenti F, Conti A, Bigiarini S, Gualtieri S, Casula C, Ticali PF, Pini R. Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol. Eur J Trauma Emerg Surg 2015; 44:805-810. [PMID: 26683569 DOI: 10.1007/s00068-015-0620-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/07/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan. METHODS A prospective accuracy study was performed from November 2012 to November 2013 at the Emergency Department. Only adult trauma patients who underwent a CA-FAST examination prior to a thoracoabdominal CT scan were enrolled. In addition to standard patterns detected by Extended-FAST (E-FAST) such as pneumothorax (PTX), hemothorax (HTX), pericardial and intraabdominal effusion, CA-FAST protocol also included the research of lung contusions (LCs). RESULTS Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %. CONCLUSION According to our results CA-FAST protocol proved to be a rapid bedside method, with good accuracy and high NPV in detection of ultrasonographic patterns suggestive of serious injury in trauma patients; moreover, the additional research of LCs did not cause a delay in the diagnosis. Ultrasonography should be used as initial investigation during the primary survey, sending to further diagnostic studies (CT scan) only those patients not clearly classified.
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Affiliation(s)
- M Zanobetti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - A Coppa
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - P Nazerian
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Grifoni
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - M Scorpiniti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - F Innocenti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - A Conti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Bigiarini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Gualtieri
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - C Casula
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - P F Ticali
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - R Pini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
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20
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Wongwaisayawan S, Suwannanon R, Prachanukool T, Sricharoen P, Saksobhavivat N, Kaewlai R. Trauma Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2543-2561. [DOI: 10.1016/j.ultrasmedbio.2015.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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21
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Talari H, Moussavi N, Abedzadeh-Kalahroudi M, Atoof F, Abedini A. Correlation Between Intra-Abdominal Free Fluid and Solid Organ Injury in Blunt Abdominal Trauma. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e29184. [PMID: 26566511 PMCID: PMC4636749 DOI: 10.5812/atr.29184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/01/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022]
Abstract
Background: In previous studies, the diagnostic value of Focused Assessment with Sonography for Trauma (FAST) has been evaluated but few studies have been performed on the relationship between the amount of free intra-abdominal fluid and organ injury in blunt abdominal trauma. To select patients with a higher probability of intra-abdominal injuries, several scoring systems have been proposed based on the results of FAST. Objectives: The aim of this study was to determine the prognostic value of FAST according to the Huang scoring system and to propose a cut-off point for predicting the presence of intra-abdominal injuries on the Computed Tomography (CT) scan. The correlation between age and Glasgow Coma Scale (GCS) and the presence of intra-abdominal injuries on the CT scan was also assessed. Patients and Methods: This study was performed on 200 patients with severe blunt abdominal trauma who had stable vital signs. For all patients, FAST-ultrasound was performed by a radiologist and the free fluid score in the abdomen was calculated according to the Huang score. Immediately, an intravenous contrast-enhanced abdominal CT scan was performed in all patients and abdominal solid organ injuries were assessed. Results were analyzed using Kruskal-Wallis test, Mann-Whitney test and ROC curves. The correlation between age and GCS and the presence of intra-abdominal injuries on CT-scan was also evaluated. Results: The mean age of the patients was 29.6 ± 18.3 years and FAST was positive in 67% of the subjects. A significant correlation was seen between the FAST score and the presence of organ injury on CT scan (P < 0.001). Considering the cut-off point of 3 for the free fluid score (with a range of 0-8), sensitivity, specificity, positive predictive value and negative predictive value were calculated to be 0.83, 0.98, 0.93, and 0.95, respectively. Age and GCS showed no significant correlation with intra-abdominal injuries. Conclusions: It seems that FAST examination for intra-abdominal fluid in blunt trauma patients can predict intra-abdominal injuries with very high sensitivity and specificity. Using the scoring system can more accurately determine the probability of the presence of abdominal injuries with a cut-off point of three.
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Affiliation(s)
- Hamidreza Talari
- Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Nushin Moussavi
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Nushin Moussavi, Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540026, Fax: +98-3155548900, E-mail:
| | | | - Fatemeh Atoof
- Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Arezoo Abedini
- Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran
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22
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Limchareon S, Jaidee W. Physician-performed Focused Ultrasound: An Update on Its Role and Performance. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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23
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Rajabzadeh Kanafi A, Giti M, Gharavi MH, Alizadeh A, Pourghorban R, Shekarchi B. Diagnostic accuracy of secondary ultrasound exam in blunt abdominal trauma. IRANIAN JOURNAL OF RADIOLOGY 2014; 11:e21010. [PMID: 25763079 PMCID: PMC4341171 DOI: 10.5812/iranjradiol.21010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/20/2013] [Accepted: 01/01/2014] [Indexed: 11/20/2022]
Abstract
Background: In stable patients with blunt abdominal trauma, accurate diagnosis of visceral injuries is crucial. Objectives: To determine whether repeating ultrasound exam will increase the sensitivity of focused abdominal sonography for trauma (FAST) through revealing additional free intraperitoneal fluid in patients with blunt abdominal trauma. Patients and Methods: We performed a prospective observational study by performing primary and secondary ultrasound exams in blunt abdominal trauma patients. All ultrasound exams were performed by four radiology residents who had the experience of more than 400 FAST exams. Five routine intraperitoneal spaces as well as the interloop space were examined by ultrasound in order to find free fluid. All patients who expired or were transferred to the operating room before the second exam were excluded from the study. All positive ultrasound results were compared with intra-operative and computed tomography (CT) findings and/or the clinical status of the patients. Results: Primary ultrasound was performed in 372 patients; 61 of them did not undergo secondary ultrasound exam; thus, were excluded from the study.Three hundred eleven patients underwent both primary and secondary ultrasound exams. One hundred and two of all patients were evaluated by contrast enhanced CT scan and 31 underwent laparotomy. The sensitivity of ultrasound exam in detecting intraperitoneal fluid significantly increased from 70.7% for the primary exam to 92.7% for the secondary exam. Examining the interloop space significantly improved the sensitivity of ultrasonography in both primary (from 36.6% to 70.7%) and secondary (from 65.9% to 92.7%) exams. Conclusions: Performing a secondary ultrasound exam in stable blunt abdominal trauma patients and adding interloop space scan to the routine FAST exam significantly increases the sensitivity of ultrasound in detecting intraperitoneal free fluid.
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Affiliation(s)
| | - Masoumeh Giti
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Alizadeh
- Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ramin Pourghorban
- Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Shekarchi
- Department of Radiology, 501 Hospital, AJA University of Medical Sciences, Tehran, Iran
- Corresponding author: Babak Shekarchi, Department of Radiology, 501 Hospital, AJA University of Medical Sciences, Shahid Etemadzadeh Av., West Fatemi St., P.O. Box: 14117-18541, Tehran, Iran. Tel: +98-9125032079, E-mail:
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24
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Arhami Dolatabadi A, Amini A, Hatamabadi H, Mohammadi P, Faghihi-Kashani S, Derakhshanfar H, Tabatabaee SM, Moghimi M, Kabir A. Comparison of the accuracy and reproducibility of focused abdominal sonography for trauma performed by emergency medicine and radiology residents. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1476-1482. [PMID: 24613553 DOI: 10.1016/j.ultrasmedbio.2014.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 01/13/2014] [Accepted: 01/17/2014] [Indexed: 06/03/2023]
Abstract
We compared the diagnostic accuracy of emergency medicine residents (EMRs) and radiology residents (RRs) in performing focused abdominal sonography for trauma (FAST). The cohort in this prospective study comprised 200 unstable patients (163 males and 37 females; mean ± standard deviation of age, 34.3 ± 16.4 y) who presented with trauma. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. Patients with positive FAST results underwent further diagnostic procedures such as computed tomography, diagnostic peritoneal lavage and laparotomy. Those with negative FAST results underwent clinical follow-up for 72 h until their condition deteriorated or they were discharged. Sensitivity, specificity, positive and negative predictive values and accuracy in evaluating free intraperitoneal fluid were 80%, 95%, 57%, 98% and 94% when FAST was performed by EMRs and 86%, 95%, 59%, 98% and 94% when FAST was performed by RRs. The level of agreement between EMRs and RRs was moderate (κ = 0.525). FAST is a useful screening tool for initial assessment of free abdominal fluid in patients with trauma. Our results indicate that EMRs can perform sonography on trauma patients as successfully as RRs.
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Affiliation(s)
- Ali Arhami Dolatabadi
- Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Amini
- Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Hatamabadi
- Safety Promotion & Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Mohammadi
- Haft-e-Tir Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Faghihi-Kashani
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hojjat Derakhshanfar
- Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehrdad Moghimi
- Department of Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Department of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Yıldız MK, Ozkan E, Odabaşı HM, Eriş C, Günay E, Abuoğlu HH, Kaya B, Yardımcı S, Müftüoglu MT, Topaloglu U. Analysis of 120 patients with abdominal stab wound focusing on diagnostic role of fast. Int J Clin Exp Med 2014; 7:1386-1390. [PMID: 24995100 PMCID: PMC4073761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the managemant results of patients with penetrating abdominal injuries. MATERIAL AND METHODS One hundred twenty (120) patients who were admitted to the Emergency Department of Haydarpasa Numune Training and Research Hospital between December 2003 and December 2010 with abdominal stab wounds were included to retrospective study. The data of all patients regarding age, gender, FAST and CT results, injured organs, surgical procedures, length of hospital stay, follow-up were examined. USG findings were classified as follows: true positive (TP), in cases of positive USG findings, and positive laparotomy; true negative (TN), in cases of negative USG findings, and negative physical examination and follow-up findings; false negative (FN), in cases of negative USG findings, and positive laparotomy; and false positive (FP), in cases of positive USG findings, and negative physical examination and follow-up findings. Abdominopelvic CT extended from the lower chest to the symphysis pubis. CT was performed by administering radiopaque agents via intravenous (i.v.) rectal or oral route. RESULTS One hundred twenty (120) patients who were admitted to the Emergency Department of Haydarpasa Numune Training and Research Hospital between December 2003 and December 2010 with stab abdominal injuries were hospitalized. According to USG findings, 45.7% were TP, 82.4% were TN, 10.6% were FN, and 34.3% were FP. Thirty-five patients with hemodynamic stability and positive FAST findings and 15 patients with positive hemodynamic stability but negative FAST findings underwent computed tomography. CONCLUSION Serial FAST and CT help guide treatment for stable patients with penetrating sharp injuries to the abdomen.
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Affiliation(s)
- Mehmet Kamil Yıldız
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital Turkey
| | - Erkan Ozkan
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital Turkey
| | - Hacı Mehmet Odabaşı
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital Turkey
| | - Cengiz Eriş
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital Turkey
| | - Emre Günay
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital Turkey
| | - Hacı Hasan Abuoğlu
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital Turkey
| | - Bulent Kaya
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital Turkey
| | - Samet Yardımcı
- Department of General Surgery, Marmara University Medical Faculty Turkey
| | - Ma Tolga Müftüoglu
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital Turkey
| | - Umit Topaloglu
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital Turkey
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Kasotakis G, Duggan M, Li Y, O'Dowd D, Baldwin K, de Moya MA, King DR, Alam HB, Velmahos G. Optimal pressure of abdominal gas insufflation for bleeding control in a severe swine splenic injury model. J Surg Res 2013; 184:931-6. [DOI: 10.1016/j.jss.2013.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/01/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
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Kumar S, Sagar S, Subramanian A, Albert V, Pandey RM, Kapoor N. Evaluation of amylase and lipase levels in blunt trauma abdomen patients. J Emerg Trauma Shock 2013; 5:135-42. [PMID: 22787343 PMCID: PMC3391837 DOI: 10.4103/0974-2700.96482] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 06/06/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA). AIM To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. MATERIALS AND METHODS A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged). Wilcoxon's Rank sum or Kruskal-Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. RESULTS A total of 55 patients with median age 26 (range, 6-80) years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT) or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) on days 1, 3, and 5, were found to be significant. Day 1 serum amylase, AST, ALT, hemoglobin, and hematocrit levels were found significant in patients who had spleen injury. Serum amylase levels on day 5 and ALP on day 3 were significant in patients who had GIT injury. Urine amylase levels on day 5 were found to be statistically significant in patients who had kidney injury. In patients with isolated organ injury to the liver or spleen, the levels of urine amylase were elevated on day 1 and gradually decreased on days 3 and 5, whereas in patients with injury to GIT, the urine amylase levels were observed to gradually increase on days 3 and 5. CONCLUSION Although amylase and lipase levels in the serum and urine are not cost-effective clinical tools for routine diagnosis of extra-pancreatic abdominal injuries in BTA, but when coupled with other laboratory tests such as liver enzymes, they may be significant in predicting specific intra-abdominal injury.
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Affiliation(s)
- Subodh Kumar
- Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
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Smith ZA, Wood D. Emergency focussed assessment with sonography in trauma (FAST) and haemodynamic stability. Emerg Med J 2013; 31:273-7. [DOI: 10.1136/emermed-2012-202268] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFocussed assessment with sonography in trauma (FAST) has assumed a key role in the rapid non-invasive assessment of thoracoabdominal trauma and assists in decreasing disposition time. This study evaluates FAST's efficacy with respect to haemodynamic stability in a South African emergency department (ED).MethodsData were collected prospectively by four emergency medicine doctors trained in emergency ultrasonography. FAST scans were performed by one ED doctor and timings, scan result and disposition were recorded. Patient haemodynamic stability was assessed by the emergency doctor performing the scan; subjectively at the time of scanning and objectively using calculation of the shock index. All scan results were subsequently verified by a second ED doctor in a blinded fashion and by CT scanning or operative intervention when clinically indicated.Results166 FAST scans were conducted of which 36 (21.7%) were positive. Mean age was 30.6 years (SD 12.8). 74.1% of patients sustained blunt traumatic injury. Doctors’ subjective haemodynamic stability assessments had higher specificity, sensitivity and predictive values than shock index alone. Haemodynamic instability and a positive FAST result were significantly related (p=0.004). Sensitivities and specificities of FAST scans for blunt and penetrating trauma were 93.1% and 100%, and 90.0% and 100%, respectively. Corresponding values for pneumothoraces were 84.6% and 100%.DiscussionThis study showed a valuable role for FAST in all traumas, particularly in haemodynamic compromise. As an addition to the physician's repertoire of bedside assessment tools, it improves diagnostic capabilities in comparison with simple haemodynamic assessments alone.
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Shojaee M, Faridaalaee G, Sabzghabaei A, Safari S, Mansoorifar H, Arhamidolatabadi A, Keyghobadi F. Sonographic Detection of Abdominal Free Fluid: Emergency Residents vs Radiology Residents. Trauma Mon 2013; 17:377-9. [PMID: 24350131 PMCID: PMC3860662 DOI: 10.5812/traumamon.5476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/16/2012] [Accepted: 09/10/2012] [Indexed: 11/23/2022] Open
Abstract
Background Focused assessment with sonography for trauma (FAST) has become a part of initial examinations in trauma care at emergency departments (ED). Objectives The goal of the present study was to evaluate the accuracy of FASTs performed by emergency residents (ER) in detection of abdominal free fluid following blunt trauma. Materials and Methods In this study, the reports of ERs performing FASTs on 286 admitted patients following blunt trauma were compared with those of radiology residents (RR) in relation to presence of abdominal free fluid. In addition, the reports of the two resident groups were compared with the final abdominal outcome, based on the results of abdominal computed tomography (CT) and clinical follow up. Results The ERs had reported abdominal free fluid in 20 (6.9%) patients while RRs performing FAST had positive results in 22 (7.6%) patients. The reports of FASTs revealed significant correlation between the two resident groups (P < 0.001). ERs performing FASTs had 90% sensitivity and 98.5% specificity in comparison to RRs sonography reports. Furthermore, ER-performed FASTs had 96.5% accuracy in relation to final outcome. Conclusions Following training, ED residents can perform FAST with high accuracy and specificity, similar to RR residents, in patients with blunt abdominal trauma.
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Affiliation(s)
- Majid Shojaee
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Gholamreza Faridaalaee
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Gholamreza Faridaalaee, Department of Emergency Medicine, Imam Hossein Hospital, Shahid Madani Avenue, 1617763141, Tehran, IR Iran. Tel: +98-2177558081, Fax: +98-2177556069, E-mail:
| | - Anita Sabzghabaei
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Saeed Safari
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Emergency Medicine Department, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Hamid Mansoorifar
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ali Arhamidolatabadi
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Keyghobadi
- Emergency Medicine Department, Alzahra Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Ultrasonographic diagnosis of abdominal free fluid: accuracy comparison of emergency physicians and radiologists. Eur J Trauma Emerg Surg 2012; 39:9-13. [PMID: 26814918 DOI: 10.1007/s00068-012-0219-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Blunt abdominal trauma is a diagnostic challenge for emergency physicians and ultrasonography is one of the diagnostic tools used in this type of injuries. The aim of this study was to evaluate the diagnostic value of ultrasonographies performed by emergency physicians and radiologists. METHODS This prospective diagnostic study was performed in the emergency departments of two trauma centers in Iran during a period of 12 months. The subjects were all patients with blunt abdominal trauma that were candidated for abdominopelvic computed tomography (CT) scanning in our emergency departments. The results of focused assessment with sonography for trauma (FAST) performed by emergency physicians and radiologists were compared blindly with the results of CT scans performed by radiologists. The sensitivity, specificity, and predictive values of diagnosis for different abdominal anatomic areas were calculated. RESULTS In total, 450 patients undergoing FAST and CT scanning were studied. The sensitivity of radiologists' diagnoses for Morison's, splenorenal, perivesical, and pleural effusion areas were, respectively, 88.0, 70.0, 38.0, and 30.0 %. The corresponding values for emergency physicians' diagnoses were, respectively, 82.0, 60.0, 28.0, and 30.0 %. The specificity of radiologists' diagnoses in the mentioned areas were, respectively, 98.9, 100, 93.1, and 100 %, and for emergency physicians, they were, respectively, 98.9, 100, 96.0, and 100 %. CONCLUSION Emergency physicians showed a promising performance in applying FAST in blunt abdominal trauma. The specificity of ultrasonographic diagnosis in the emergency physicians group and the radiologists group were comparable, while radiologists showed a higher performance regarding the sensitivity of the ultrasonographic diagnosis.
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Patterson BO, Holt PJ, Cleanthis M, Tai N, Carrell T, Loosemore TM. Imaging vascular trauma. Br J Surg 2011; 99:494-505. [DOI: 10.1002/bjs.7763] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2011] [Indexed: 01/06/2023]
Abstract
Abstract
Background
Over the past 50 years the management of vascular trauma has changed from mandatory surgical exploration to selective non-operative treatment, where possible. Accurate, non-invasive, diagnostic imaging techniques are the key to this strategy. The purpose of this review was to define optimal first-line imaging in patients with suspected vascular injury in different anatomical regions.
Methods
A systematic review was performed of literature relating to radiological diagnosis of vascular trauma over the past decade (2000–2010). Studies were included if the main focus was initial diagnosis of blunt or penetrating vascular injury and more than ten patients were included.
Results
Of 1511 titles identified, 58 articles were incorporated in the systematic review. Most described the use of computed tomography angiography (CTA). The application of duplex ultrasonography, magnetic resonance imaging/angiography and transoesophageal echocardiography was described, but significant drawbacks were highlighted for each. CTA displayed acceptable sensitivity and specificity for diagnosing vascular trauma in blunt and penetrating vascular injury within the neck and extremity, as well as for blunt aortic injury.
Conclusion
Based on the evidence available, CTA should be the first-line investigation for all patients with suspected vascular trauma and no indication for immediate operative intervention.
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Affiliation(s)
- B O Patterson
- St George's Vascular Institute, St George's University of London, London, UK
| | - P J Holt
- St George's Vascular Institute, St George's University of London, London, UK
| | - M Cleanthis
- Imperial College Regional Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - N Tai
- Trauma Clinical Academic Unit, Barts and the London NHS Trust, London, UK
| | - T Carrell
- National Institute for Health Research Comprehensive Biomedical Research Centre of Guy's and St Thomas' NHS Foundation Trust and Department of Vascular Surgery, King's College London, London, UK
| | - T M Loosemore
- St George's Vascular Institute, St George's University of London, London, UK
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Holliman CJ, Mulligan TM, Suter RE, Cameron P, Wallis L, Anderson PD, Clem K. The efficacy and value of emergency medicine: a supportive literature review. Int J Emerg Med 2011; 4:44. [PMID: 21781295 PMCID: PMC3158547 DOI: 10.1186/1865-1380-4-44] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 07/22/2011] [Indexed: 11/10/2022] Open
Abstract
Study objectives The goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established. Methods The January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included. Results A total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM residencies (24 articles), and overviews and editorials of EM efficacy and value (35 articles). Conclusion There is extensive medical literature that supports the efficacy and value for both EM as a medical specialty and for emergency patient care delivered by trained EM physicians.
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Affiliation(s)
- C James Holliman
- The Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, and George Washington University School of Medicine and Health Sciences, Bethesda, MD, USA.
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Davis VW, Wallace JM, Ahern MT, Dawson MS, Battaglia DF, Sherwood KL, Sugerman SA, Mallin MP, Madsen TE. Mid-level providers demonstrate proficiency in FAST after directed training. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0070-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction
Focused Assessment with Sonography for Trauma (FAST) is commonly used to detect intra-peritoneal blood as part of the evaluation of trauma patients. In our level 1 trauma center, mid-level providers (MLPs) perform serial FAST exams on trauma patients. We describe our training approach and proficiency achieved.
Methods
Subjects were MLPs with no previous training in FAST. The training consisted of hands-on training on live models, two on-line ultrasound (US) modules, and a video image review session. Participants were evaluated with pre-, post-, and 6-month follow-up video tests. Subsequently, they independently performed FAST exams which were reviewed by ED US faculty.
Results
11 MLPs participated, completing an average of 17 scans; 91% were technically adequate. Average scores were: pre-test 50.5% (31.7–68.3%), post-test 76.7% (65.9–87.8%), and 6-month test 77% (58.5–87.8%), for an initial improvement of 26.2% (p < 0.001) and a sustained improvement over the pre-test of 26.5% (p = 0.011) at 6 months.
Conclusion
MLPs demonstrated proficiency in FAST after brief training.
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Abdominal Trauma: Never Underestimate It. Case Rep Emerg Med 2011; 2011:850625. [PMID: 23326699 PMCID: PMC3542897 DOI: 10.1155/2011/850625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 08/09/2011] [Indexed: 11/30/2022] Open
Abstract
Introduction. We present a case of a sports injury. The initial presentation and clinical examination belied serious intra-abdominal injuries. Case Presentation. A 16-year-old male patient came to emergency department after a sports-related blunt abdominal injury. Though on clinical examination the injury did not seem to be serious, FAST revealed an obscured splenorenal window. The CT scan revealed a large left renal laceration and a splenic laceration that were managed with Cook coil embolization. Patient remained tachycardic though and had to undergo splenectomy, left nephrectomy, and a repair of left diaphragmatic rent. Patient had no complication and had normal renal function at 6-month followup. Conclusion. The case report indicates that management of blunt intra-abdominal injury is complicated and there is a role for minimally invasive procedures in management of certain patients. A great deal of caution is required in monitoring these patients, and surgical intervention is inevitable in deteriorating patients.
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Edwards H. Let's All Jump on the Ultrasound Bandwagon: Further Debate on the Use of Ultrasound. ULTRASOUND 2010. [DOI: 10.1258/ult.2009.009003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
No imaging technique is more popular or more in demand than ultrasound. But should it be considered a specialist technique to be employed only by highly trained professionals or as a readily available tool to be used by many? This paper will discuss some of the implications of having ultrasound performed by a range of individuals and will emphasize the importance of training and regulation.
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Affiliation(s)
- Hazel Edwards
- Department of Radiology, Lister Hospital, Corey's Mill Lane, Stevenage SG1 4AB, UK
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